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Diabetes in young adults, children drastically increases risk for sudden cardiac death
ANAHEIM, Calif. — Young adults and children with type 1 or type 2 diabetes have a greater risk for all-cause mortality and sudden cardiac death compared with their peers without diabetes, according to new research presented at the American Heart Association Scientific Sessions.
Jesper Svane, BM, of the cardiology department at the Copenhagen University Hospital, and colleagues used data from Danish registries to determine mortality rates in people with and without diabetes.
Prescription information was used to determine diagnosis of type 1 (treatment with insulin or insulin-analogs only) and type 2 diabetes (antidiabetic agents with or without insulin).
The study population included all persons in Denmark aged 1 to 35 years in 2000 to 2009 and 36 to 49 years in 2007 to 2009.
A total of 14,294 deaths were reported in the 10-year period; 5% had diabetes, of which 70% had type 1 diabetes and 30% had type 2 diabetes.
People with diabetes had an increased rate of all-cause mortality compared with those without diabetes (mortality rate ratio = 5; 95% CI, 4-5, P < .001). Cardiac disease was the leading cause of death in those with diabetes (34%).
Of those with diabetes, 17% suffered sudden cardiac death, which was significantly higher than those without diabetes (mortality rate ratio = 7; 95% CI, 6-9, P < .001). Sudden cardiac death was caused by CAD in 47% by sudden arrhythmic death syndrome in 26% of those with autopsies.
“These findings highlight the need for increased awareness on cardiovascular risk factors and management among young persons with diabetes, particularly those with diabetes type 1 who tend to receive less attention in this respect in clinical practice,” Svane told Cardiology Today. – by Cassie Homer
Reference:
Svane J, et al. Presentation M3127. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, California.
Disclosure: Svane reports no relevant financial disclosures.
Perspective
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The Danish registry is simply an opportunity to look back. One of the limitations was that these are data-drilling operations. That doesn’t make them wrong. It just makes one raise hypotheses as to why the outcomes are what were assessed.
In older patients, we see more autopsies, and many of them have coronary disease, which you might expect, but in the younger patients with type 1 diabetes that die suddenly, I’d like to know more about their hemoglobin A1C, their insulin management, their glucose variability and things that could relate to cardiac rhythm disturbances.
To lose a 17-year-old girl or boy with hypoglycemia is unacceptable, but hypoglycemic death does occur in patients with type 1 diabetes. Now we have the tools to enable us to manage diabetes much more effectively. It is now important for the investigators to go back and reexamine their data from those younger people particularly, young adults or adolescents who die suddenly and find out more about them.
Perspective
Back to TopThe interesting part about the diabetic study is that it highlights for us a group of folks at risk. Most of these were arrhythmic deaths. In particular, the risk for long QT syndrome in that subgroup is really where our concerns are. Screening these young people is an important issue. Should we be rethinking this idea of doing screening ECGs in young people is the question that gets raised.